Building on the vision of an integrated primary care

This is a challenging time for primary care, with patients seeking timely access to services and continuity of care, and primary care staff under intense pressure as they work to meet rising demand.

Simply carrying on with existing ways of working will not provide a sustainable solution. GP and NHS Assembly member Clare Fuller has published a stocktake of primary care, recommending integrated neighbourhood teams making use of all available assets should be at the heart of the NHS in future.

Primary care must be supported to deliver what patients need and national leaders should provide resources to tackle workforce shortages, invest in new buildings and facilities, and extend use of digital technologies.

The Fuller stocktake builds on insights and best practice from across England and sets out a vision based on:

  • supporting teams and services to work in a much more integrated way across health and social care and public health, including co-locating staff in integrated neighbourhood teams
  • providing those people who get ill but don’t use services very often with much more choice on how they access care when they need it;
  • providing more proactive, personalised care with multi-disciplinary teams of professionals and putting patients, who may have complex needs, including those with multiple long-term conditions, at the centre;
  • improving patient experience, with single care records and integrated plans supporting general practice to provide the continuity of care that patients so value; and
  • helping people to stay well for longer as part of a more ambitious and joined-up approach to prevention for the whole of health and care.

This way of working already exists in some parts of the country. The stocktake heard a range of examples, including a live primary care capacity and demand management system in Yorkshire, an integrated clinical pharmacy service in the Wirral, a single clinical community leadership programme in Suffolk and North East Essex Integrated Care System, holistic primary care estates profiling and planning in Dorset, and anticipatory care in Frimley.

Drawing on nine workstreams and four task and finish groups, the review outlines a vision that has already attracted support from primary care leaders. The challenge now is to ensure the widespread adoption and adaptation of new care models recognising the stakes are incredibly high. It is no exaggeration to say that if primary care fails, so does the NHS, underlining the urgency of translating the vision into meaningful improvements for patients and staff.

We are particularly heartened that the review’s recommendations have been developed jointly by leaders from across the NHS working with NHS England and a wide range of partners. The commitment of Integrated Care System chief executives to work together and with partners in their own areas to implement these recommendation gives us hope that action will happen. The review is right to argue that a key challenge will be to pivot away from top-down directives and create an environment that supports local change, not dictates it from the centre.

Where the centre does have a role is in ensuring that sufficient resources are available to take the review’s ideas forward. The Fuller review has thrown down the gauntlet and the onus is now on NHS, national and government leaders to respond.

Chris Ham is currently Co-Chair of the NHS Assembly, Chair of the Coventry and Warwickshire Health and Care Partnership, and non-executive director of the Royal Free London Hospitals NHS Foundation Trust. He is emeritus professor of health policy and management at the University of Birmingham, visiting professor at the London School of Hygiene and Tropical Medicine and Senior Visiting Fellow at The King’s Fund where he was Chief Executive between 2010 and 2018. He is an expert adviser to Carnall Farrar.

Chris is the author of over 20 books and numerous articles on health policy and management. During his career, he has worked at the universities of Leeds, Bristol and Birmingham from where he was seconded to the Department of Health to work as the Director of the Strategy Unit between 2000 and 2004. He works at the interface between research and policy drawing on evidence to inform decision making.

Chris has advised the World Bank and the WHO as well as the governments of New Zealand and Sweden. He has served as an advisor in the UK to the Audit Commission, the House of Commons Health Committee and the National Audit Office. He has also been a board member of the Canadian Health Services Research Foundation and the Canadian Institutes of Health Research.

He is a founding fellow of the Academy of Medical Sciences, a fellow of the Royal Society of Medicine and a former vice-president of the Patients’ Association.

Chris was awarded a CBE for his services to the NHS in 2004 and a knighthood for services to health policy and management in 2018. He was made an honorary fellow of the Royal College of Physicians of London in 2004 and an honorary fellow of the Royal College of General Practitioners in 2008. He became a companion of the Institute of Healthcare Management in 2006.

Chris is a regular contributor to radio and TV and writes for the national press on issues concerned with health policy and management.

Professor Dame Clare Gerada

Professor Dame Clare Gerada has more than 35 years experience practising medicine, and has been a driving force behind efforts to provide more wellbeing support for NHS staff. As well as being the first female Chair of the Royal College of General Practitioners (RCGP) in 50 years, Clare has held leadership roles with the Department of Health and is on the Council of the British Medical Association.

In the Millennium Birthday Honours Dr Gerada received an MBE for services to medicine and substance misuse. She was awarded a Fellowship of the Royal College of Physicians in 2008 and was made an Honorary Fellow of the Royal College of Psychiatrists in July 2013. Clare was awarded a damehood in the Queen’s Birthday Honours in 2020.